Uncommon Etiology of Pancreatic Mass: a Case Report.

IgG4-related autoimmune pancreatitis (AIP) is a chronic inflammatory disease of the pancreas with a distinct histological feature. Its diagnosis remains challenging as some features overlap with pancreatic cancer. We present a case of IgG4-related AIP mimicking pancreatic cancer. A 70-year-old male patient presented with epigastric pain, radiating to the entire abdomen with an unquantified weight loss. Magnetic resonance cholangiopancreatography (MRCP) showed a mass with a 28 mm long axis, in the head of the pancreas with pancreatic duct dilatation. Thus, it was presumed to be a pancreatic neoplasm and pancreatic resection was undertaken without a definitive preoperative diagnosis. In terms of clinical presentation, imaging characteristics, and laboratory parameters, IgG4-related AIP can resemble pancreatic cancer. Thus, histopathological studies remain the gold standard for a definitive diagnosis that may show a diffuse lymphoplasmacytic infiltrate with storiform fibrosis. On immunohistochemistry, the majority of plasma cells are positive for IgG4 (>50 per high-power field (HPF)). In our case, the histologic diagnosis allowed us to suggest the diagnosis of IgG4-related AIP and the immunohistochemical diagnosis confirmed the diagnosis. It is critical to distinguish pancreatic cancer from IgG4-related AIP due to its completely different prognosis and therapy. Steroids are the first-line treatment that allow a reduction of risk of relapse; therefore, a misdiagnosis as a malignancy leads to inappropriate surgical interventions. In this case, a biopsy is recommended.

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Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.